The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

The elastic strain energy of growth ledges on coherent and partially coherent precipitates

The formation rate of growth ledges on a faceted precipitate strongly affects the growth kinetics and the shape of the precipitate. An Eshelby-type model is used to compare the strain energy associated with the nucleation of a ledge on different facet planes of a body-centered cubic (bcc) precipitate in face-centered cubic (fcc) matrix. Ledge nucleation is only likely at facet areas where the interaction energy between the ledge and the precipitate is negative. The strain energy for ledge formation is not symmetric on any of the facet planes, but it is symmetric about the center of the precipitate. For coherent precipitates comparable to those observed in the Ni-Cr system, ledges form with the lowest strain energy on the broad facet of the precipitate implying that precipitate thickening should occur faster than lengthening and widening. A procedure for modifying the Eshelby model is suggested in order to allow strain-energy calculations of partially coherent precipitates. The strain energy for ledge formation on at least one type of partially coherent lath is lowest for a ledge located on the facet perpendicular to the crystallographic invariant line (IL). This situation favors precipitate lengthening in the invariant line direction. © 1994 The Minerals, Metals and Materials Society, and ASM International